“Federal officials are floating the idea of expanding Medicare’s Pioneer model for accountable care organizations, but they might struggle to recruit any new participants.
Some prominent ACO leaders shared their skepticism in letters to the CMS that the agency released this month. The program, designed and administered by the CMS Innovation Center, is the government’s earliest and most aggressive test under the Patient Protection and Affordable Care Act of new financial incentives for hospitals and doctors to hold down medical costs and meet quality targets.
The Pioneer initiative’s rules put doctors and hospitals at too much risk of losing money with too little control, officials with Universal American, CHE Trinity Health, St. Vincent’s Health Partners, the Franciscan Alliance and others said in the comment letters to federal officials.
Pioneers must agree to accept potential losses with the promise of bonuses after the first year. ACOs participating in the Medicare shared-savings program, in contrast, can go three years without the risk of owing Medicare money if they fall short.
“Organizations are not gravitating toward the Pioneer ACO model because the downside risk is not outweighed by the opportunity for economic gain—the business case is not compelling,” wrote officials with CHE Trinity Health, a Michigan-based system. The system’s CEO is Dr. Richard Gilfillan, who oversaw the launch of Pioneer ACOs as the Innovation Center’s director before his departure last June.”